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FOR OFFICE SE: f-- ----.1%C APPLICATION FOR"SAWATION PERMIT Permit No. ...._/......�'__.. -------------------------- ----------------------------- {Complete in Duplicate) �/ This Permit Expires 1 Year From Date Issued Date Issued __..___.��.... ...-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. bi _ s� ._. = . JOB ADDRESS A LOCATION.. f��___cf . --- Owner's Name 4�j .� --------------- --•----------- Phone.------------------------------- �� Address.................. =/tel • - --- ._ ... ...� i l Contractor's Name---...........•--•-----� - -- - ------------------•-------------------------------- ...._.------------ Phone................................... 00* Installation will serve: Residence We Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. . Number of bedrooms J._ Number of baths/ejL Lot size .. .f+-X.. ._s�....................... Water Supply: :Public system ❑ Community system ❑ Private ®/Depth To Water Table . ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Kjo-gardpan ❑ Previous Application Made: (If yes,date--------------------) No q3l' New Construction: Yes 2�No ❑ FHA/VA: Yes Rg-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _____Distance from foundat�ion____P........Material--- �:'-_ _. ...........:.... No. of compartments------�-------------Sizea�d�_"k"__7*k_-� .quid depth....7-!�-------------Capacity./X+pQ.__ :� ,e�-0----- to nearest lot line._4—.... f _ I Disposal Field, �1 Distance from nearest ell- COI.._,_Distance from foundation_... ..____ rr ------ --- --------Length of each line_--�+� ---y-_---.Width of trench-------�------__.---.-.__--. [� I, Number of lines___.__.. .. g it Type of filter material.- ;& Depth of filter material___Ar___.______Total long+h__AJ_V_ _______________________ Seepage Pit: Distance to nearest well-----/4 *"_Distance from fo ndation___ ...._ .Disty __ ance to nearest lot line................. , Number of pits.......A----------Lining material.. .-Size: Diameter_.?.? --------Depth__r %%r.-_________________ Cesspool: Distance from nearest well-----------------Distance from foundation----------------------Lining material--____--..-_______.____.___......... ❑ Size: Diameter--------------------------------------Depth----•----------------------------------------------Liquid Capacity------------_------•------gals., Privy: Distance from nearest well------------------------------------------------Distance from nearest building._____.-________ .........I-__-___-_---. ❑ Distance to nearest lot line----------------------------------------------- -----------------------------* -•-------- Remodelin and/or repairing describe :______________ - ----- ,/�--------------4- ------------------------------------------------ ----------------------------------------------------- ------------------------------------------------------------------•--------------------------------------------------------------------------------------------------- ,.. ------•-------- ---- --------------------------------------------------------------•----------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and gules and regulations of the San Joaquin Local Health District. I "/J ______ or Contractor (Signed)-------------•------- - ----------- - -- -•-- -- -------------- ---- --- ---.....--------------- -- ---- ---..._ - -- {� ) er By:. --------- ---------------------- (rifle),. �1 1, .. _..___._._._....................... h S ~' (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY '�I APPLICATION'ACCEPTED BY--'`--•`r-' - Y---- -------------------------------------- DATE--- - --------------------- REVIEWEDBY:'----------------------------- ------- --- -----------------------------• •---------------- DATE-------==------------------------------------------------- BUILDING PERMIT ISSUED------------- ---------------- ` DATE-----------..---------__ Alterations nd/or recommen ations:------ . ----••---•1-•------------�-----•- ____ ---- ------ �� - --------------- -••----------._�.... r ----------- -----------••-•-------------------•------.--------- - -------------------------------------•------------------------------••-•---------------------------•------•----------" ----------------------------- ,.- ------------------------------ --------------- ----- ----------- FINAL INSPECTION BY: ----------------- Date..... r ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 144 Sycamore Street 2205 West 9th Street Stockton;California Lodi,California Manteca,California Tracy,California E5 9 REVISED S•59 2M 5-62 ATLAS w